Individual provider Active NPI

Wanda Alicea, LPN

  • Licensed Practical Nurse
  • Patillas, PR
National Provider Identifier
1871703660
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
031176 Issued in PA
Practice address
99 Guillermo Riefkohl St.
Patillas, PR 00723
Phone
(787) 839-4320
Fax
(787) 271-0004
NPI assigned
May 23, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 031176 PA Primary

Addresses

Primary practice location

99 Guillermo Riefkohl St.
Patillas, PR 00723

Mailing address

99 Guillermo Riefkohl St.
Patillas, PR 00723
Phone (787) 839-4320

Other identifiers 1

IdentifierTypeStateIssuer
031176OtherPRSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
031176PAMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871703660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 GUILLERMO RIEFKOHL ST.",
            "city": "PATILLAS",
            "state": "PR",
            "postal_code": "00723",
            "telephone_number": "787-839-4320",
            "fax_number": "787-271-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 GUILLERMO RIEFKOHL ST.",
            "city": "PATILLAS",
            "state": "PR",
            "postal_code": "00723",
            "telephone_number": "787-839-4320",
            "fax_number": "787-271-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALICEA",
        "first_name": "WANDA",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "PA",
            "license": "031176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "031176",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Patillas, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.